Constrictive Pericarditis: Rapid Progression of Pericardial Calcification in a Patient With Hemodialysis and Coronary Artery Bypass Surgery

Abstract

A 72-year-old man, with a history of coronary artery bypass grafting (CABG) undergone19 years previously and end-stage renal disease (ESRD) on hemodialysis since 1 year before, was admitted for evaluation of dropping arterial pressure down 1 hour after starting hemodialysis. On a computed tomography on chest scan, markedly calcified pericardium on the posterior and diaphragmatic sides of the heart was revealed. Pericardium was mostly not calcified 2 years before admission, pre-initiation of hemodialysis, and the thickness of calcified pericardium was obviously increased after initiation of hemodialysis. Constrictive pericarditis (CP) was diagnosed and subsequent pericardiectomy was underwent, and dropping atrial pressure down during hemodialysis disappeared. The main cause of CP was not cardiac surgery undergone previously (postoperative CP). It is probable that secondary hyperparathyroidism in ESRD provoked dystrophic calcification of pericardium, which was injured by past CABG, subsequent rigid and thickness of pericardium, and constrictive physiology became obvious.




J Med Cases. 2014;5(9):498-501
doi: http://dx.doi.org/10.14740/jmc1910w